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Low-dose atropine is a non-selective muscarinic antagonist that slows axial elongation of the eye — the primary driver of myopia progression. Unlike higher concentrations used for pupil dilation, 0.01% atropine is effective for myopia control with minimal blurring or photosensitivity side effects.
The only commercially available atropine eye drops in the US are 0.5% and 1% for pupil dilation. Low-dose concentrations (0.01%, 0.025%, 0.05%) for myopia control require sterile ophthalmic compounding — no FDA-approved commercial product exists at these doses.
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Myopia (nearsightedness) affects over 40% of Americans and is worsening globally. Low-dose atropine at concentrations of 0.01–0.05% has emerged as the most evidence-supported pharmacological treatment to slow myopia progression in children aged 5–16.
The landmark ATOM2 and LAMP clinical studies demonstrated that 0.01% atropine reduces myopia progression by 59–77% with minimal side effects. Because no commercial product exists at these concentrations, compounding pharmacies are the only legal source for low-dose atropine in the US.
Muscarinic Receptor Antagonism
Atropine is a non-selective muscarinic acetylcholine receptor antagonist. At standard clinical doses, it produces mydriasis (pupil dilation), cycloplegia (paralysis of accommodation), and reduced secretions. At myopia-control doses (0.01%), systemic muscarinic effects are negligible.
Axial Elongation Inhibition
The precise mechanism by which atropine slows myopia is not fully understood but is thought to involve direct action on retinal and scleral muscarinic receptors — independent of accommodation. This inhibits the scleral remodeling and axial elongation that drives increasing myopia.
Pediatric myopia control and progression prevention, slowing axial eye elongation in children, combination with orthokeratology (Ortho-K) or soft contact lenses for enhanced myopia management, high-myopia risk protocols
Pupil dilation for ophthalmic examination (higher concentrations), cycloplegic refraction, uveitis (preventing posterior synechiae), amblyopia treatment (penalization of fellow eye), pre-operative mydriasis
Standard myopia control: 0.01% atropine — 1 drop per eye nightly at bedtime
Moderate/high progression: 0.025–0.05% per prescribing ophthalmologist
Typical age range: 5–16 years
Duration: 2+ years; continued per annual eye exam assessment
Most protocols begin at 0.01% nightly in both eyes. If progression continues at 6–12 month follow-up (>0.5D/year or >0.1mm axial growth), the prescribing ophthalmologist may increase to 0.025% or 0.05%. Annual monitoring with cycloplegic refraction and axial length measurement guides dose decisions.
Ophthalmic Solution 0.01% — standard myopia control concentration; minimal side effects; most evidence-based starting dose
Ophthalmic Solution 0.025% — intermediate dose for moderate progression or inadequate response to 0.01%
Ophthalmic Solution 0.05% — higher dose for rapid progressors; slightly more photosensitivity possible
Preservative-free Unit-dose Vials — reduces preservative exposure for long-term nightly use; preferred for patients with surface sensitivity
At 0.01%: Minimal photophobia, minimal near vision blur (key advantage over higher concentrations). At 0.05%: Mild light sensitivity and slight near blur possible. Significantly better tolerated than commercial 0.5–1% ophthalmic concentrations.
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